Use of Inotropic Agents in Treatment of Systolic Heart Failure

Tariq, Sohaib; Aronow, Wilbert S.

doi:10.3390/ijms161226147

Cited by 102 publications

(83 citation statements)

References 43 publications

(49 reference statements)

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“…Moreover, in the Survival of Patients with Acute Heart Failure in Need of Intravenous Inotropic Support (SURVIVE) study including 1327 non‐PPCM patients, there was higher incidence of atrial fibrillation, hypokalemia, and headache without reduction of all‐cause mortality with levosimendan compared to dobutamine . The use of inotropic drugs in patients with CS is often limited due to the development of tachycardia, hypotension, and arrhythmias . In addition, these drugs should be used with caution during pregnancy as fetal safety is not known due to limited information …”

Section: Discussionmentioning

confidence: 99%

“…21 The use of inotropic drugs in patients with CS is often limited due to the development of tachycardia, hypotension, and arrhythmias. 21,22 In addition, these drugs should be used with caution during pregnancy as fetal safety is not known due to limited information. 23 The recommendations of the PPCM working group for the management of severe PPCM also include considerations for the use of bromocriptine.…”

Section: Discussionmentioning

confidence: 99%

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Use of Impella heart pump for management of women with peripartum cardiogenic shock

Elkayam

Schäfer

Chieffo

et al. 2019

Clinical Cardiology

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Background Percutaneous mechanical circulatory support (MCS), such as the Impella heart pump is a valuable option for cardiogenic shock (CS), although the use of Impella in CS due to peripartum cardiomyopathy (PPCM) is limited. Objective To assess outcomes in women with PPCM supported with an Impella device from the global catheter‐based ventricular assist device (cVAD) Registry. Methods and Results A total of 15 women with PPCM supported with Impella devices between November 2008 and October 2015 were included. Of the 15 women, five were treated at Hannover medical school and have been reported previously, the rest were managed at various US hospitals. The mean age was 30.0 ± 7.34 years, eight women were Caucasian, and seven were African‐American. The occurrence of PPCM was post‐delivery in eight (53.3%), at delivery in one (6.7%), and during gestation in four women (26.7%). At admission, all women had severe heart failure with a mean ejection fraction of 14.7 ± 6% and 13 women (86.7%) presented with CS. Prior to Impella, 100% were mechanically ventilated, 79% received inotropes/vasopressors, 20% supported with IABP, and 27% received veno‐arterial extracorporeal membrane oxygenation (VA ECMO) during Impella support. Two women (13.3%) died, and 13 (87.7%) survived to discharge. Eight women (53.3%) had a recovery of native heart function and six (40%) were bridged to durable left ventricular assist device (LVAD). Conclusion MCS with Impella devices can be successfully used as a bridge to early improvement, heart recovery, or successful implantation of durable LVAD in women with PPCM complicated by severe LV dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Use of Impella heart pump for management of women with peripartum cardiogenic shock

Elkayam

Schäfer

Chieffo

et al. 2019

Clinical Cardiology

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“…3,4 However, most patients in these studies were not receiving β-blockers, which remains a lingering concern. 32 We have previously demonstrated that in 1842 propensity score-matched patients with HF (30% on β-blockers), a new digoxin prescription was associated with a lower risk of 30-day all-cause readmission (17% vs 22%; HR: 0.77, 95% CI:…”

Section: Digoxin Use and Long-term Outcomesmentioning

confidence: 99%

Digoxin use and lower risk of 30‐day all‐cause readmission in older patients with heart failure and reduced ejection fraction receiving β‐blockers

Lam

Bhyan

Arundel

et al. 2018

Clinical Cardiology

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BackgroundDigoxin use has been associated with a lower risk of 30‐day all‐cause admission and readmission in patients with heart failure and reduced ejection fraction (HFrEF).HypothesisDigoxin use will be associated with improved outcomes in patients with HFrEF receiving β‐blockers.MethodsOf the 3076 hospitalized Medicare beneficiaries with HFrEF (EF <45%), 1046 received a discharge prescription for β‐blockers, of which 634 were not on digoxin. Of the 634, 204 received a new discharge prescription for digoxin. Propensity scores for digoxin use, estimated for each of the 634 patients, were used to assemble a matched cohort of 167 pairs of patients receiving and not receiving digoxin, balanced on 30 baseline characteristics. Matched patients (n = 334) had a mean age of 74 years and were 46% female and 30% African American.Results30‐day all‐cause readmission occurred in 15% and 27% of those receiving and not receiving digoxin, respectively (hazard ratio [HR]: 0.51, 95% confidence interval [CI]: 0.31‐0.83, P = 0.007). This beneficial association persisted during 4 years of follow‐up (HR: 0.72, 95% CI: 0.57‐0.92, P = 0.008). Digoxin use was also associated with a lower risk of the combined endpoint of all‐cause readmission or all‐cause mortality at 30 days (HR: 0.54, 95% CI: 0.34‐0.86, P = 0.009) and at 4 years (HR: 0.76, 95% CI: 0.61‐0.96, P = 0.020).ConclusionsIn hospitalized patients with HFrEF receiving β‐blockers, digoxin use was associated with a lower risk of 30‐day all‐cause readmission but not mortality, which persisted during longer follow‐up.

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“…Whenever possible, nephrotoxic agents should be omitted in all pre‐HTx patients. When hospitalized, these patients are candidates for intravenous inotropic support to increase cardiac output and organ perfusion . The main principles of managing renal failure (either AKI or CKD) have been described before .…”

Section: Introductionmentioning

confidence: 99%

Renal protection strategies after heart transplantation

Reichart¹,

Reichenspurner²,

Barten³

2018

Clinical Transplantation

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Renal dysfunction caused by calcineurin inhibitor (CNI) nephrotoxicity occurs often and contributes significantly to late mortality after heart transplantation (HTx). Over the last decades, this has prompted many clinical studies in an effort to develop kidney-protecting immunosuppressive strategies including delayed CNI start, minimization, withdrawal, or even de novo CNI avoidance. In the past, these strategies often failed due to the lack of efficacy. Since 2009, novel CNI-reducing strategies have been under investigation. These strategies minimize renal damage using induction agents such as antithymocyte globulin and alternative immunosuppressive agents such as the mechanistic target of rapamycin inhibitors (sirolimus or everolimus) or mycophenolate.This review outlines the recent results of using these renal protection strategies including their drawbacks. We also discuss alternative approaches to optimize individual immunosuppressive therapies after HTx. K E Y W O R D Scalcineurin inhibitors, heart transplantation, immunosuppression, mechanistic target of rapamycin inhibitors, nephrotoxicity, renal protecting strategies

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Use of Inotropic Agents in Treatment of Systolic Heart Failure

Cited by 102 publications

References 43 publications

Use of Impella heart pump for management of women with peripartum cardiogenic shock

Use of Impella heart pump for management of women with peripartum cardiogenic shock

Digoxin use and lower risk of 30‐day all‐cause readmission in older patients with heart failure and reduced ejection fraction receiving β‐blockers

Renal protection strategies after heart transplantation

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